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El objetivo de esta investigación fue conocer la relación entre la sobrecarga y las necesidades de los cuidadores primarios informales de pacientes que sufrieron traumatismo craneoencefálico. En una muestra no probabilística se aplicaron dos instrumentos a 64 cuidadores primarios que miden las necesidades (cuestionario de necesidades familiares) y sobrecarga (entrevista de sobrecarga del cuidador de Zarit), bajo un diseño transversal correlacional. Los resultados no mostraron diferencias significativas entre las categorías de las variables sociodemográficas, perosí presentaron relevancia práctica en las variables de sobrecarga, importancia de necesidades y satisfacción de necesidades. Estos resultados parecen sugerir la posibilidad de guiar estrategias de intervención hacia la satisfacción de necesidades de soporte emocional e instrumental con el objetivo de disminuir la sobrecarga en el cuidador primario informal y favorecer la calidad de vida; no obstante, es importante validar estos resultados en muestras de mayor tamaño que permitan generalizar los hallazgos.

The objective of this research was to determine the relationship between the overload and the needs of primary informal caregivers of patients suffering from a traumatic brain injury. In a non-probability sample, two instruments were applied to 64 primary caregivers measuring needs (family needs questionnaire) and overload (interview Zarit caregiver's burden), under a correlational cross-sectional design.The results showed no significant differences between categories of socio demographic variables, but had considerable practical relevance in relation to the variables of overload, importance of needs and satisfaction needs. These results seem to suggest the possibility of guiding intervention strategies towards meeting needs of emotional and instrumental support in order to reduce the burden on informal primary caregiver and promote the quality of life, however, it is important to validate these findings in larger samples that discard the possible influence of chance.

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PURPOSE: This study examined relationships between caregiver mental health and the extent to which needs were met in families of individuals with traumatic brain injury (TBI) in Mexico City, Mexico. METHOD: Sixty-eight TBI caregivers completed Spanish versions of instruments assessing their own mental health and whether specific family needs were met. RESULTS: Twenty-seven per cent of caregivers reported clinically significant depression levels, 40% reported below-average life satisfaction and 49% reported mild-to-severe burden. Several of the most frequently met family needs were in the emotional support domain, whereas the majority of unmet needs were in the health information domain. Family needs and caregiver mental health were significantly and highly related. When family needs were met, caregiver mental health was better. The strongest pattern of connections in multivariate analyses was between family instrumental support (assistance in the completion of daily life tasks) and caregiver burden, such that caregivers with less instrumental support had greater burden. Additional results suggested that instrumental support uniquely predicted caregiver satisfaction with life, burden and depression. CONCLUSIONS: Interventions for TBI caregivers, especially in Latin America, should help family members determine how best to meet their health information and instrumental needs, with the former being likely to improve caregiver mental health.

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PURPOSE: To examine differences in ratings of family dynamics between individuals with traumatic brain injury (TBI) and their family caregivers in Mexico, as well as differences in the prediction of caregiver and patient mental health outcomes from those ratings. METHOD: Forty-two patient-caregiver dyads (n = 84) from the National Institute of Rehabilitation in México City participated in a comprehensive evaluation of their family dynamics and mental health. RESULTS: Patients' and caregivers' ratings of family dynamics were significantly correlated and did not differ across five of six types of family dynamics, but caregivers rated their family's level of empathy higher than patients, p < 0.001. Additionally, all patient and caregiver ratings of family dynamics were significantly correlated. Patients', caregivers', and combined (using structural equation modeling latent constructs) ratings of family dynamics robustly predicted four times as many caregiver mental health outcomes as patient mental health outcomes. CONCLUSIONS: Family dynamics influence both TBI patient and caregiver mental health but much more so in caregivers. Research on families of individuals with TBI in Mexico should incorporate both patient and caregiver perspectives to more comprehensively depict the environment in which TBI rehabilitation occurs.

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OBJECTIVE: To examine the patterns of family dynamics that are most associated with the mental health of traumatic brain injury (TBI) caregivers from Mexico. It was hypothesized that healthier family dynamics would be associated with better caregiver mental health. DESIGN: A cross-sectional study of self-reported data collected from TBI caregivers through the Mexican National Institute of Rehabilitation in Mexico City, Mexico, the premier public medical facility in Mexico that provides rehabilitation services to patients with various disabilities. SETTING: One public outpatient medical and rehabilitation facility. PARTICIPANTS: Sixty-eight caregivers of individuals with moderate-to-severe TBI from Mexico City, Mexico, were related to an individual with TBI who was ≥3 months after injury, a primary caregiver for ≥3 months, familiar with the patient's history, and without neurologic or psychiatric conditions. The average (standard deviation) age of caregivers was 50.94 ± 12.85 years), and 82% were women. METHODS: The caregivers completed Spanish versions of instruments that assessed their own mental health and family dynamics. MAIN OUTCOME MEASUREMENTS: Outcomes assessed included family dynamics (Family Adaptability and Cohesion Evaluation Scale-Fourth Edition; Family Communication Scale; Family Satisfaction Scale; Family Assessment Device-General Functioning; and Relationship-Focused Coping Scale), and caregiver mental health (Patient Health Questionnaire-9, Zarit Burden Interview, and Satisfaction with Life Scale). RESULTS: Results of canonical correlation analyses suggested that caregiver mental health and family dynamics were positively related, with a large effect size. Caregivers with high family satisfaction and cohesion tended to have a low burden and high satisfaction with life. In addition, caregiver depression and burden were positively related to each other and were both inversely related to caregiver satisfaction with life. CONCLUSIONS: TBI caregiver interventions in Latino populations would likely benefit from including programming or techniques to improve family dynamics, especially family cohesion, given the strong potentially reciprocal influence of these dynamics on caregiver mental health.

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OBJECTIVE: To examine the system of connections among traumatic brain injury (TBI) patient social functioning, family functioning, and caregiver depression and burden in Mexico. DESIGN: Cross-sectional survey. SETTING: A public medical facility. PARTICIPANTS: Mexican TBI patient-caregiver dyads (N=84) participated in this study. Most of the patients with TBI were men (81%), with an average age ± SD of 38.83±13.44 years. The majority of caregivers (86%) were women, with an average age ± SD of 51.74±11.29. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Outcomes assessed included family functioning (Family Satisfaction Scale), patient social functioning (Medical Outcomes Study 36-Item Short-Form Health Survey), and caregiver mental health (Patient Health Questionnaire-9 and Zarit Burden Interview). RESULTS: A moderated mediation path model found that patient social functioning and family functioning predicted caregiver burden, and caregiver burden mediated the effect of family functioning on caregiver depression. Caregivers with strong family functioning tended to have low burden, no matter the level of patient social functioning. This path model provided an excellent fit and explained 47% of the variance in caregiver burden and 36% of the variance in caregiver depression. CONCLUSIONS: In Mexico, strong family functioning is an important buffer in the relationship between TBI patient social functioning deficits and caregiver mental health, especially because familism is a core value in Latino culture. Rehabilitation interventions designed to strengthen family functioning may improve caregiver mental health, thereby influencing the quality of informal care that caregivers are able to provide.

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Much of what is known about family functioning in the face of traumatic brain injury (TBI) is based on research conducted in the United States. The purpose of this study was to (1) describe the levels of family adaptability, cohesion, communication, and satisfaction as reported by Mexican TBI survivors and their family caregivers, (2) test the hypothesis of the Circumplex Model that balanced families would exhibit better communication and greater satisfaction, and (3) explore how TBI survivors' and their family caregivers' perceptions of family adaptability and cohesion influenced their own and the other's perceptions of family communication and satisfaction. In the majority of dyads, both the TBI survivor and the family caregiver endorsed balanced family adaptability and cohesion. Both TBI survivors and their family caregivers reported a relatively high level of family communication and satisfaction. TBI survivors and family caregivers who reported greater levels of family adaptability and cohesion also endorsed better family communication and greater family satisfaction. In addition, individuals with TBI whose family caregiver endorsed balanced family adaptability and cohesion reported better family communication. Further, family caregivers of TBI survivors who reported balanced family adaptability and cohesion reported better family communication. Implications for research and practice are discussed.

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